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Opción, Año 36, Regular No.91 (2020): 249-262 ISSN 1012-1587/ISSNe: 2477-9385
Recibido: 20-12-2019 •Aceptado: 20-02-2020
Determinant social factors influencing obesity
among Malay people
Norizan Abdul Ghani1
1Faculty of Applied Social Sciences, Universiti Sultan Zainal Abidin,
21300, Kuala Terengganu, Malaysia.
Saif Ullah2
2Faculty of Applied Social Sciences, Universiti Sultan Zainal Abidin,
21300, Kuala Terengganu, Malaysia.
Atif Amin Baig3
3Faculty of Medicine, Universiti Sultan Zainal Abidin, 20400, Kuala
Terengganu, Malaysia.
Jumadil Saputra4
4School of Social & Economic Development, University Malaysia
Terengganu, 21030, Kuala Terengganu, Malaysia.
M. Umair Khan5
5Faculty of Economics and Management Sciences, Universiti Sultan
Zainal Abidin, 20400, Kuala Terengganu, Malaysia.
Abstract
This study has explored the determinant social factors of obesity
among Malay obese people. Multiple regressions analysis (stepwise
method) was performed to identify and examine the most influenced
factors that contribute to obesity. The analysis determined that eating
habits, physical activity barriers, and feelings (low self-esteem) are
dominating social factors. However, among these factors eating habits
were observed as the most influencing predictor in the model. In
conclusion, this pioneering study is providing baseline data of
influencing factors of obesity in Malaysia, so future researches may be
conducted based on the given results to reduce the obesity trend.
250 Norizan Abdul Ghani et al. Opción, Año 36, Regular No.91 (2020): 249-262
Keywords: Social factors, Influencing factors, Obesity, Malay
race.
Factores sociales determinantes que influyen en la
obesidad entre los malayos
Resumen
Este estudio ha explorado los factores sociales determinantes de
la obesidad entre las personas obesas malayas. Se realizó un análisis de
regresiones múltiples (método por pasos) para identificar y examinar
los factores más influenciados que contribuyen a la obesidad. El
análisis determinó que los hábitos alimenticios, las barreras de
actividad física y los sentimientos (baja autoestima) son factores
sociales dominantes. Sin embargo, entre estos factores, los hábitos
alimenticios se observaron como el predictor más influyente en el
modelo. En conclusión, este estudio pionero está proporcionando datos
de referencia de los factores que influyen en la obesidad en Malasia,
por lo que se pueden realizar investigaciones futuras basadas en los
resultados dados para reducir la tendencia a la obesidad.
Palabras clave: Factores sociales, Factores de influencia,
Obesidad, Raza malaya.
1. INTRODUCTION
Obesity worldwide considers a health issue, and its prevalence
increased in both developed and developing countries. Furthermore, it
is also related to physical and mental problems in an individual and
community (DJALALINIA, 2015). Obesity develops a substantial
adverse impact on health status. The increased ratio of obesity will
lead to cardiovascular diseases and poor health. Malaysian ranked
higher in both overweight and obese categories, which may lead to a
higher mortality rate besides the economic burden of the country.
Determinant social factors influencing obesity among malay people 251
Globally, 3.4 million people have died due to the problem of weight
gain and obesity in 2010.
It was explicitly noted that obesity had significantly increased
the death risk, but overweight had a blurred image (FLEGAL,
GRAUBARD, WILLIAMSON & GAIL, 2005). A Nationwide survey
conducted by Institute of Public Health has revealed that 2.6 million
(15.22%) Malaysian adult people have diabetes problem and around
5.8 million (32.7%) have hypertension, and this figure is rising in next
national survey where 3.5 million (17.7%) people are diabetics, and
9.6 million (47.7%) of the adult population has hypertension. Further,
Tan explained that in Malaysia, three out of five deaths occurred due
to obesity-related health problems.
Further, studies have shown the indirect costs due to obesity in
terms of absenteeism (CAWLEY, RIZZO & HAAS, 2007) reduce the
productivity presenteeism (SCHMIER, JONES & HALPERN, 2006),
injuries at the workplace (POLLACK & CHESKIN, 2007), and
disability payments (RICCI & CHEE, 2005). In Australia, the
estimated monetary value was up to $A8.28 -13824 in 2008 that
includes the care costs $1.9billion (23%), loss of productivity $3.6
billion and health system $2.0 billion (24%). Interestingly the facts
showed that a 1% reduction in the pervasiveness of BMI would be cost
savings of $US 43 million in 2030, and $US 85 million in 2050
(RTVELADZE, MARSH, BARQUERA, ROMERO, LEVY,
MELENDEZ & BROWN, 2014). Therefore, the measures would be in
need for the interventions towards obesity concerning to reduce the
252 Norizan Abdul Ghani et al. Opción, Año 36, Regular No.91 (2020): 249-262
health care costs (AHMAD & AHMAD, 2019; RTVELADZE ET AL.,
2014). Malaysia also suffers the highest cost for obesity as a
percentage of the country's healthcare spending, reaching an alarming
to 10-20%. Among other ASEAN countries, Indonesia ranks second
with costs at 8-16% of healthcare spending, while Singapore comes
third, with costs at 3-10%.
Most researchers tend to involved in genetics and nutrients parts
for the interventions of obesity, but there is a lack of knowledge
regarding social factors associated with obesity in Malaysia especially
in Kuala Terengganu. SAUNDERS (2012) determined that social
factors have a critical role in human weight gain. Further, Ullah
explained the correlation between various social factors. The nominal,
ordinal and scale based items were used to gather the data. According
to the study, feelings (low self-esteem), body image dissatisfaction,
eating habits, physical activity, physical activity barriers, and media
influence were significantly associated with obesity. However, this
study did not mention the most determinant factors of obesity among
the Malay race. There is also a need to identify the most determinant
social factors influencing obesity among Malay obese people which
will cover in this present study.
2. METHODOLOGY
This cross-sectional sectional was carried out among Malay
obese people residing in Kuala Terengganu. 150 obese samples were
Determinant social factors influencing obesity among malay people 253
decided to include in the study. According to ABDOLLAHI & ABU
TALIB (2016), the minimum sample size required for the study is 100
respondents (COHEN, MANION & MORRISON, 2000; AHMAD &
AHMAD, 2018). However, While, BABBIE (1990) mentioned that
60% of the response ratio would be necessary for the research
specifically in surveys to reduce the level of non-response bias
(FINCHAM, 2008; AHMAD & SAHAR, 2019). Among 150 obese
Malay people, 80 (53.3%) were males, and 70 (46.7%) were females.
Further, the convenience sampling method was undertaken to
recruit the participants. The inclusion criteria were (1) Obese aged 20
to 59 years old (BMI >27.49 Kg/m2 ), (2) Respondent who were
willing to participate voluntarily, (3) Respondent can read, write and
understand English and Bahasa Melayu, (4) Both Male and Female
obese individuals and (5) Malay ethnicity. For exclusion criteria, (1)
Obese aged below 20 and more than 59 years old (BMI < 27.49 Kg/m2
), (2) Respondent who were not willing to participate, (3) Respondent
who cannot read, write and understand questionnaire in Bahasa
Melayu and English very well, (4) Pregnant respondent, and (5) Non-
Malay ethnicity.
BMI of participants was obtained by given guidelines of
Clinical Practice Guidelines on Management of Obesity. All the
calculations were recorded in a standard formation, and the BMI was
classified according to the weight status of an individual.
254 Norizan Abdul Ghani et al. Opción, Año 36, Regular No.91 (2020): 249-262
Data collection was conducted from June 2017 to November
2017. The information was gathered from UniSZA (Gong Badak
Campus and medical campus), Universiti of Malaysia Terengganu, and
Sultan Nur Zahirah Hospital. The participants were approached who
fulfilled the inclusion criteria and willing to participate voluntarily for
this study. The researcher explained the objective of the research to the
participants and obtained verbal consent. The response rate was
90.5%. Further, data was entered into SPSS version 23.0 Multiple
regressions analysis (stepwise method) was performed to explore the
most influenced social factor among the population.
Table 1: Classification of BMI in Asian Adults given by Clinical
Practice Guidelines on Management of Obesity
BMI Weight Status
18.5 – 22.9 Normal and Healthy Weight
23.00 - 27.49 Overweight
27.50 - 34.99 Obese I
(35.00 - 39.99) Obese II
>40 kg/m2 Obese III
Data collection was conducted from June 2017 to November
2017. The information was gathered from UniSZA (Gong Badak
Campus and medical campus), Universiti of Malaysia Terengganu, and
Sultan Nur Zahirah Hospital. The participants were approached who
fulfilled the inclusion criteria and willing to participate voluntarily for
this study. The researcher explained the objective of the research to the
participants and obtained verbal consent. The response rate was
90.5%. Further, data was entered into SPSS version 23.0. Multiple
Determinant social factors influencing obesity among malay people 255
regressions analysis (Stepwise method) was performed to explore the
most influenced social factor among the population.
3. RESULTS
Table 2 shows the regression analysis of the model summary of
ANOVA and coefficients. It shows that the regression model has been
performed at three steps. It means, three most important and
significant variables were identified and correspondingly R-Square
(coefficient of determination) mentioned in Table 2. R-square showed
that at three steps, using three variables, 43.2% variation could explain
in the dependent variable.
Table 2: Model Summary of Eating habits, Physical Activity Barriers,
& Feelings (low self-esteem) on Obesity
Model R R Square Adjusted R
Square
Std. The
error of the
Estimate
1 0.556a 0.309 0.304 3.256
2 0.640b 0.410 0.402 3.019
3 0.657c 0.432 0.420 2.976
a. Predictors: (Constant), eating habits
b. Predictors: (Constant), eating habits, physical activity barriers
c. Predictors: (Constant), eating habits, physical activity barriers,
feelings
(low self-esteem)
d. Dependent Variable: Obesity
256 Norizan Abdul Ghani et al. Opción, Año 36, Regular No.91 (2020): 249-262
The result of ANOVA as per given in Table 3 indicated that F
value was significant at F (37.034), p < 0.0.5.
Table 3: ANOVA
Model Sum of
Squares
df Mean
Square
F Sig.
1 Regression 702.032 1 702.032 66.232 0.000b
Residual 1568.740 148 10.600
Total 2270.772 149
2 Regression 931.439 2 465.719 51.116 0.000c
Residual 1339.333 147 9.111
Total 2270.772 149
3 Regression 981.272 3 327.091 37.034 0.000d
Residual 1289.499 146 8.832
Total 2270.772 149
Eating habits, physical activity barriers, and feelings (low self-
esteem) were the most significant factors respectively. All these three
variables have p-values < 0.05. Beta coefficients showed the individual
impact of variables on the dependent variable. The regression
coefficient value, its sign, and corresponding p-value are observed.
Except for feelings (low self-esteem), the other two variables have a
significantly positive role in increasing obesity of subjects. Feelings
(low self-esteem) have an average negative impact on the dependent
variable. It explained that a person having low self-esteem would
increase the level of obesity and vice versa. Standardised coefficients
have shown that eating habits are the most strong predictor in the final
model.
Determinant social factors influencing obesity among malay people 257
Table 4: Test of Hypothesis (Regression Coefficients)
Model Unstandardized
Coefficients
Standardized
Coefficients
t Sig.
B Std.
Error
Beta
1 (Constant) 19.288 2.085 9.252 0.000
Eating
habits
0.451 0.055 0.556 8.138 0.000
2 (Constant) 15.879 2.049 7.751 0.000
Eating
habits
0.344 0.056 0.424 6.186 0.000
Physical
activity
barriers
0.216 0.043 0.344 5.018 0.000
3 (Constant) 20.579 2.825 7.284 0.000
Eating
habits
0.324 0.055 0.400 5.861 0.000
Physical
activity
barriers
0.229 0.043 0.365 5.362 0.000
Feelings
(low self-
esteem)
-0.090 0.038 -0.150 -
2.375
0.019
Dependent Variable: Obesity
Table 5 indicates that body image dissatisfaction (β = .127, p >
0.05), physical activity (β = -.045, p > 0.05), and media influence (β =
-.141, p > 0.05) were found to be insignificant and were excluded
accordingly.
258 Norizan Abdul Ghani et al. Opción, Año 36, Regular No.91 (2020): 249-262
Table 5: Excluded Variables (Stepwise-Based)
Model Beta In t Sig.
1 Feelings (low self-
esteem)
-0.106b -1.551 0.123
Body image
dissatisfaction
0.312b 4.547 0.000
Physical activity -0.105b -1.528 0.129
Physical activity
barriers
0.344b 5.018 0.000
Media influence -0.095b -0.689 0.492
2 Feelings (low self-
esteem)
-0.150c -2.375 0.019
Body image
dissatisfaction
0.123c 1.147 0.253
Physical activity -0.056c -0.854 0.394
Media influence -0.193c -1.510 0.133
3 Body image
dissatisfaction
0.127d 1.204 0.231
Physical activity -0.045d -0.694 0.489
Media influence -0.141d -1.096 0.275
4. DISCUSSION
The findings of this study asserted the determinant factors of
obesity. The regression analysis (Stepwise method) eliminated the
variables such as body image dissatisfaction, physical activity and
media influence in the final model, yet these factors cannot be
neglected. From the results, it can be determined that eating habits,
physical activity barriers, and feelings (low self-esteem) are the most
dominant factors which are influencing obesity.
Determinant social factors influencing obesity among malay people 259
However, eating habits are performing vital their role in order to
increase the obesity level. There may be a change of eating outside
frequently among Malay people. A study conducted by Lim revealed
that people are dining out 13 times per week in Malaysia. Another
reason may be explained that Malay people preferred to consume
sweet drinks and beverages instead of water during meals. Factors
such as working mothers, food varieties (both local and international),
sweet drinks and beverages served at many premises encouraged the
practice of eating-out. Restaurants, night markets (Pasar Malam), food
courts and food stalls were servicing not only those who wanted to eat
at meal times but also those who wanted to enjoy food with
friends/family members in a festive and relaxed manner. Food caterers
were also available to serve at formal functions (meetings, seminars) in
offices and home during religious and family occasions.
Income inequalities may actuate differences in lifestyle, for
example, exercise, eating habits, and cigarette smoking. National
Health and Morbidity Survey determined the lower level of vegetable
utilization in men with a low salary than that in men with a high salary.
Fruit and meat utilization was lesser in participants with lower income
than that in participants with high income among both sexes.
Therefore, lack of consideration of nutrient contents, irregular eating
time, poor food quality and premises’ cleanliness might expose the
practitioner to health, social, familial and even safety risks.
Moreover, physical activity barriers described their influence on
obesity. It shows how obese Malay people are experiencing physical
260 Norizan Abdul Ghani et al. Opción, Año 36, Regular No.91 (2020): 249-262
activity barriers which are leading to obesity. To decrease the obesity
trend, the state government should observe the barriers at the personal
and social level when creating interventional programs to promote
physical activity. Therefore, understanding physical activity barriers is
very important.
Moreover, third variable feelings (low self-esteem) also showed
it significant importance affecting obesity which may be due to the
mediating role of body image dissatisfaction which compels an
individual towards unhealthy dieting or emotional eating. As obesity is
a rising issue and distressing the Malay obese people, so eating habits
are worth evaluation among several factors to cure obesity problems.
The government should come up with interventional programs that
will cover these neglected factors to avoid people from obesity.
Further, more researches are expected to clarify whether feelings (low
self-esteem) and physical activity barriers interact with eating habits or
not among Malay obese people.
5. CONCLUSION
This pioneering study has evaluated the strong influence of
eating habits on obesity. Other determinant social factors were
physical activity barriers and feelings (low self-esteem). There is a
need to inculcate good habits of healthy eating and regular physical
exercise among Malay obese people. Also, initiatives to promote
exercise may also need to focus on physical activity barriers among the
Determinant social factors influencing obesity among malay people 261
population. This study is providing a baseline data of influencing
factors in Malaysia and emphasized researchers to conduct further
studies by aligning the given results to decrease the burden of obesity
from the country.
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UNIVERSIDAD
DEL ZULIA
Revista de Ciencias Humanas y Sociales
Año 36, N° 91 (2020)
Esta revista fue editada en formato digital por el personal de la Oficina de
Publicaciones Científicas de la Facultad Experimental de Ciencias,
Universidad del Zulia.
Maracaibo - Venezuela
www.luz.edu.ve
www.serbi.luz.edu.ve
produccioncientifica.luz.edu.ve